Laparoscopic

management of Ectopic
Pregnancy
 Background & Indications
• Although the salpingectomy is definitive surgical
management of a tubal ectopic pregnancy, it hinders
future fertility by removing the oviduct.
• Thus salpingotomy were sought
• In this procedure, an incision on the antimesentric aspect
of the tube allows extraction of the gestational tissue with
preservation of the tube.
• Experience have demonstrated that, haemostasis
without closure of the tubal incision provide similar tubal
patency to primary closure of the tube.
• Healing by secondary intention.
• Laparoscopy is becoming the standared
management of unruptured ectopic
pregnancy.
• Advantages over minilaparotomy.
 Conservative therapy of ectopic
pregnancy
• Pharmacological therapy using methotrexate was
introduced by TANAKA 1982.
• proven to be successful in 90% of selected cases.
• The American College of Obstetrician and
Gynaecologists recommend Methotrexate for patients
who desire future fertility and have an ectopic mass less
than 3 cm in diameter, with hCG level less than
15,000mIU/mL and no evidence of fetal heart tone on
ultrasonography.
• Follow up is by monitorin hCG.
• Tubal patency is 80% in both surgical and
pharmacological therapy.
• This leads to an intrauterine pregnancy rate of 75% after
salpingotomy, compared to 44% after salpingectomy.
 Procedure
• Even for a patient who is thought to be a
candidate for conservative therapy, access to
the peritoneal cavity is essential to determine the
most appropriate procedure.
• Linear salpingotomy if for ectopic in ampulla with
unruptured tubal serosa.
• Incision is made on antimesentric side using
monopolar electrocautery, laser or harmonic
scalple.
• The products of conception are teased from the
tubal lumen using, suction, forsceps of
hydrodissection.
• Haemorrhage is controlled using bipolar forceps.
• Persistant blood oozing render some surgeons
inject diluted vasopressin in the mesosalpinx.
• Tubal incision is left to heal by secondary
intension.
• According to the wish of patient either
salpingotomy or salpingectomy is performed.
• Conception tissue either removed from 10
mm port, or from a colpotomy .
• Colpotomy is fascilitated by streching the
posterior vaginal wall.
• Colpotomy later is closed using
absorbable sutures